Emergencies Flashcards
Normal ranges for the vital sings: 1) temperature, 2) pulse, 3) respiratory rate, 4) BP and 5) oxygen saturation
1) 36.6-37.2 degrees C
2) 60-90 bpm
3) 12-20 breaths
4) 120/80 mmHg
5) 94-98%
How to take pulse-rate and things to comment on
-Use 2 fingers at Radial artery. Record for 20s then x3
-Is it weak (about to faint) or strong (hyperventilating)
-Regularly irregular
-Irregular irregular (AF)
How to treat someone hyperventilating
Low blood CO2
So Breath in paper bag to re-breath the CO2 you are exhaling
How a blood pressure cuff works. What is classed as hypertensive
> 140/90 consistently
Cuff pumped up to occlude brachial artery, then pressure is slowly released, when blood returns this is the systolic pressure – force blood exert when heart contracts. 2nd figure is diastolic which is the pressure when heart is at rest
Oxygen flow rate for most medical emergencies
15l per minute
The antagonist for opioids and benzodiazepine
-opioide overdoe= naloxone
-BDZ= flumazenil
Give examples of high protein bound drugs, and therefore high likely of drug interactions
-Asprin, warfarin, carbamazepine, digoxin, phenytoin
if highly bound then not very active. If 2 of these drugs used then competition for protein binding. The loser will have more free unbound drug in circulation so more active and increased concentration
eg. aspirin displaced warfarin from protein which increases distribution of unbound warfarin increasing anticoagulation
Role of cytochrome P450. Give examples of drugs that induce and inhibit
-family of drug metabolising enzymes in the liver
-if stimulated then decreased plasma concentration of drug, decreasing its duration of action
-Inducers: prednisolone, omeprazole, carbamazepine
-Inhibators: azoles, metronidazole, erythromycin, SSRIs
Explain pharmaceutical, Phamicokinetic and pharmodynamic drug interactions
- Pharmaceutical: two chemically incompatible substances when mixed together (milk and tetracycline = COLLATES – none into bloodstream)
- Pharmacokinetic: Modification of action of drug X by drug Y because Y alters concentration of X reaching site of action. Changes to absorption, distribution, metabolism, excretion (eg. Aspirin and warfarin)
- Pharmacodynamic: Drugs with opposite actions compete against each other. Y alters X without altering its conc (eg. Beta blocker with beta agonist)
Interaction between azole anti fungals and warfarin
-Azole antifungals compete for cytochrome metabolism with warfarin
-Decreased clearance of warfarin (inhibit elimination)
-Elevated blood concentrations of warfarin= Prolonged effects = increased anticoagulation and INR
Treatment for aspirin overdose
IV injection of potassium salt and sodium bicarbonate to make the urine more alkaline. Aspirin (weak acid) is eliminated more quickly in urine when the pH is sufficiently high.
NSAIDs and methotrexate interaction
NSAIDs decrease secretion of Methotrexate = increasing its concentration which blocks DNA synthesis
Interaction between penicillin and aspirin, and penicillin and methotrexate
-ASPIRIN AND PENICILLIN = less reabsorption for Aspirin = prolongs half‐life of Penicillin
-Methotrexate and Penicillin = INTERACTION. Increased MTX toxicity
Give examples of antagonism of pharmacodynamic drug interactions
-ß blocker with ß agonist: propranolol + salbutamol
-Insulin and glucagon
-Histamine and omeprazole
Give examples of synergism of pharmacodynamic drug interactions
-CNS depressants = Alcohol + BDZ or antipsychotic/ opiate
-Sodium Valproate and BDZ
-NSAIDS and Corticosteroids = increased risk PEPTIC ULCERATION
-Aspirin and Warfarin
-SSRIs and Triptan= increasing 5HT
